POS1328 DO IL-1 ANTAGONISTS DEFINITELY PROTECT FROM THE DEVELOPMENT OF NEW DAMAGE: A SINGLE-CENTER STUDY
Authors: D. Yildirim, R. C. Kardaş, B. Ozkiziltas, I. Vasi, H. Küçük, M. A. Ozturk, S. Haznedaroglu, B. Goker, A. Tufan
Journal: Annals of the Rheumatic Diseases (2022)

Background Ongoing inflammatory episodes of familial Mediterranean fever (FMF) disease can cause damage in nearly all organ systems. Colchicine and interleukin1β blocking agents are successfully used to control the disease activity [1]. Although the effect of IL-1 blockers are known for controlling disease activity and amyloidosis [2], it is unclear whether they prevent organ damage Objectives In our study, we assessed the organ damage in patients with FMF treated with colchicine and IL-1 antagonists (IL-1A). It was evaluated whether new damage occurred after IL-1 antagonist treatment. Methods A total of 111 patients fulfilling Tel-Hashomer criteria and treated with IL-1A due to colchicine resistance were included in the study. All patients were also treated with colchicine with a maximum-tolerable dose. Patients were grouped according to their recent damage status (no damage, pre-existing damage, and damage developed under IL-1A treatment). The degree of damage was determined using Autoinflammatory Disease Damage Index (ADDI) and modified form of ADDI (mADDI) [3, 4]. Results 44 patients (42,3%) had damage according to the modified ADDI (mADDI) index; three patients experienced new damage under IL-1 antagonist treatment while four patients showed progression of damage and mADDI score. In patients with a positive mADDI score, the most common damage was amyloidosis (n=28, 63%), the second most frequent was musculoskeletal findings (N=14, 31%), and the third was infertility (N=2, 0,04%). The most common domains of FMF-related damage with IL-1 antagonist treatment were musculoskeletal (n=4), renal (n=2) and reproductive system (n=2) Conclusion Our study was the first study to evaluate the progression of damage in patients with FMF and treated- with IL-1 antagonists. Although it is known that IL-1A is effective in colchicine-resistant patients, physicians should be aware that damage can still develop under IL-1A treatment. References [1]Chae JJ, Aksentijevich I, Kastner DL. Advances in the understanding of familial Mediterranean fever and possibilities for targeted therapy. Br J Haematol 2009; 146:467–78. [2]Ozcakar ZB, Ozdel S, Yilmaz S, Kurt-Sukur ED, Ekim M et al. Anti-IL-1 treatment in familial Mediterranean fever and related amyloidosis. Clinical Rheumatology 2016; 35 (2): 441- 446. doi: 10.1007/s10067-014-2772-2 [3]Ter Haar NM, Annink KV, Al-Mayouf SM et al.: Development of the autoinflammatory disease damage index (ADDI). Ann Rheum Dis 2017; 76: 821-30 [4]Babaoglu H, Armagan B, Bodakci E, Satis H, Atas N, Sari A, Yasar Bilge NS, Bilici Salman R, Yardimci GK, Avanoglu Guler A, Karadeniz H, Kilic L, Ozturk MA, Goker B, Haznedaroglu S, Kalyoncu U, Kasifoglu T, Tufan A. Factors associated with damage in patients with familial Mediterranean fever. Clin Exp Rheumatol. 2020 Sep-Oct;38 Suppl 127(5):42-48. Table 1. Comparison of clinical and laboratory parameters between groups according to damage No damage New damage Any damage P value Age (years) 48,4 56,4 67,5 0,002 Sex (K/E) 34/33 2/5 25/19 NS Follow-up time (years) 40 43 56 0,33 Dominant attack type Peritonitis(63,7%) NA Arthritis(34,1%) NS Persistent inflammation 33,6 42,3 44,3 0,05 AIDAI score 39 40 48 NS Mutations M694V/M694V 26 2 14 NS M694V/any 44 4 38 M694V/M680I 3 1 4 M680I/any 11 9 •SAIDAI: Auto-Inflammatory Diseases Activity Index Acknowledgements All participants were confirmed for both participation and publication. Local Ethical Committee approved the study Disclosure of Interests None declared